Toxic effects of phenothiazines on the eye

Boet, Dirk

doi:10.1007/bf00153873

Cited by 17 publications

(7 citation statements)

References 94 publications

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“…chlorpromazine), and the resulting compounds show as lens discolouration. [3,6,61,62] Reversibility of these eye lesions is not always possible; it depends on the causative agent and on the degree of structural changes. [63][64][65] Visual disturbance varies, depending on the severity of the ocular changes.…”

Section: Cataract and Pigmentary Deposits In The Lens And Corneamentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

176

143

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All psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects. Visual adverse effects can be divided into seven major categories: eyelid and keratoconjunctival disorders; uveal tract disorders; accommodation interference; angle-closure glaucoma; cataract/pigmentary deposits in the lens and cornea; retinopathy; and other disorders. The disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium. Chlorpromazine, at high dosages, can commonly cause abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea. It can also cause a more worrisome but rarer visual impairment, namely corneal oedema. Lithium can rarely lead to a bothersome eye irritation by affecting sodium transport. Uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs). TCAs, typical antipsychotics and SSRIs can all cause mydriasis that is often transient and with no major consequences, but that can promote closure of angles in susceptible patients. Topiramate has been frequently associated with a number of significant ocular symptoms including acquired myopia and angle-closure glaucoma. Problems with accommodation are related to TCAs and to low-potency antipsychotics. TCAs cause transient blurred vision in up to one-third of patients. Angle-closure glaucoma is a serious condition that has been mainly associated with TCAs, low-potency antipsychotics, topiramate and, to a lesser extent, SSRIs. When patients with narrow angles are given TCAs, they all appear to experience induction of glaucomatous attacks. Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma. Cataractous changes can result from antipsychotics, mainly from high dosages of chlorpromazine or thioridazine. These two drugs, when used at high dosages and for prolonged periods, frequently cause lenticular opacifications. Retinopathy has been shown to be related to high dosages of typical antipsychotics, mainly chlorpromazine and thioridazine. The frequency of occurrence of retinal effects seems to be proportional to the total amount of drug used over a long period of time. Other visual problems of special concern are the ocular dystonias, other eye movement disorders, and decreased ability to perceive colours and to discriminate contrast. Ocular dystonias can occur with antipsychotics (especially high-potency ones), carbamazepine (especially in polytherapy), topiramate and, rarely, with SSRIs. Disturbance in various eye movements is frequently seen with benzodiazepines, antiepileptic drugs and lithium. Impairment in the perception of colours and the discrimination of contrasts has been shown to occur not uncommonly with carbamazepine and lorazepam. Thus, typical antipsycho...

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Section: Cataract and Pigmentary Deposits In The Lens And Corneamentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

176

143

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“…However, this very likely occurs only after abnormally high dosages or after very long intake, and even then not in all individuals (Boet,, 1970). Optic atrophies caused by clioquinol (Enterovioform, Mexaform) were no longer observed when this drug could not be acquired freely anymore.…”

mentioning

confidence: 99%

Electro-ophthalmology and side-effects of drugs

Lith

1977

Doc Ophthalmol

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Diagnostic procedures have to be directed towards the prevention of irreversible changes. In this respect, patients using chloroquine have to be examined at least once a year. The most sensitive methods for detecting early reversible changes are the electro-oculogram and static perimetry. The latter is probably more specific. Concerning ethambutol, the patients themselves are aware of the onset because a decrease in visual acuity and a central scotoma are early and reversible symptoms. In these cases electro-ophthalmology is of help when the diagnosis is doubtful. Iatrogenic effects of other drugs are not seen regularly in our electro-ophthalmological departments.

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“…(References: Bar et al, 1983;Bock and Swain, 1963;Boet, 1969;Boet, 1970;Cant, 1969;Delong et al, 1965;Dencker and Enoksson, 1966;Greiner and Berry, 1964;Lutz, 1975;Mathalone, 1967;Rashussen et al, 1976;Speltor et al, 1976. )…”

Section: Nervous System Drugsmentioning

confidence: 99%

The Marton Lecture: Ocular Manifestations of Systemic Medication

Gilmartin

1987

Ophthalmic Physiologic Optic

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The probability of ocular adverse reactions to systemic medication is low but when a reaction does occur it is often associated with one or more special factors relating to the condition being treated, to the patient, and to the nature of the drug itself. Nevertheless the role of the optometrist in the monitoring, detection and reporting of adverse reactions is important and is recognized by the College reporting scheme. A selection of the type of reactions that may be encountered in general optometric practice is reviewed. The reactions range from the relatively innocuous anticholinergic effects of the benzodiazepine tranquillizers to the more serious corneal, lens and retinal changes that may be associated with the corticosteroids, phenothiazines and chloroquine.

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Toxic effects of phenothiazines on the eye

Cited by 17 publications

References 94 publications

Ocular Adverse Effects of Common Psychotropic Agents

Ocular Adverse Effects of Common Psychotropic Agents

Electro-ophthalmology and side-effects of drugs

The Marton Lecture: Ocular Manifestations of Systemic Medication

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